Hostname: page-component-5db58dd55d-688nx Total loading time: 0 Render date: 2026-07-09T12:49:21.571Z Has data issue: false hasContentIssue false
  • English
  • Français

Performing Regulation: Transcending Regulatory Ritualism in HIV Clinics

Published online by Cambridge University Press:  01 January 2024

Carol A. Heimer  and
J. Lynn Gazley
Get access Rights & Permissions [Opens in a new window]

Abstract

Sociolegal scholars suggest that regulatory encounters often are occasions for displaying a surface compliance decoupled from day-to-day practice. Yet ethnographic data from five highly regulated HIV clinics show that regulatory encounters open opportunities both for ritualism and—surprisingly—for transcending ritualism. Using a theatrical analogy, we argue that improv performance is the technology that enables regulatory inspectors and clinic staff to transcend ritualism. As regulatory encounters unfold, clinics' carefully prepared performances sometimes change into more cooperative interactions where inspectors and regulatees hash out details about how rules will be applied and even work together on reports for the regulators' supervisors. By “performing together,” regulatory inspectors gain access to the clinic's backstage where they can assess clinic workers' deeper conformity to ethical and scientific norms. But such joint performances are less likely where cultural divides and material scarcity make it difficult for clinic staff to gain inspectors' trust.

Information

Type
Articles
Information
Law & Society Review , Volume 46 , Issue 4 , December 2012 , pp. 853 - 887
Copyright
© 2012 Law and Society Association.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

We are deeply grateful for thoughtful comments from current and previous editors of LSR, three anonymous reviewers, and our Northwestern colleagues, including especially Arthur Stinchcombe. The data for this article were collected for “Clinic-Level Law: The ‘Legalization’ of Medicine in AIDS Treatment and Research,” a project supported by the American Bar Foundation, the National Science Foundation (NSF SES – 0319560, PI Carol Heimer), and the Russell Sage Foundation.

References

Bardach, Eugene, & Kagan, Robert A. (2002 [1982]) Going by the Book: The Problem of Regulatory Unreasonableness. Piscataway, NJ: Transaction Publishers.Google Scholar
Berg, Marc (1997) Rationalizing Medical Work: Decision-Support Techniques and Medical Practices. Cambridge, MA: MIT Press.Google Scholar
Black, Julia (2001) “Decentring Regulation: Understanding the Role of Regulation and Self-Regulation in a ‘Post-Regulatory’ World,” 54 Current Legal Problems 103–46.CrossRefGoogle Scholar
Braithwaite, John (2008) Regulatory Capitalism: How it Works, Ideas for Making It Work Better. Cheltenham, UK, & Northampton, MA: Edward Elgar.CrossRefGoogle Scholar
Braithwaite, John, & Braithwaite, Valerie (1995) “The Politics of Legalism: Rules versus Standards in Nursing-Home Regulation,” 4 Social & Legal Studies 307–41.CrossRefGoogle Scholar
Braithwaite, John, et al. (2007) Regulating Aged Care: Ritualism and the New Pyramid. Cheltenham, UK, & Northampton, MA: Edward Elgar.CrossRefGoogle Scholar
Braithwaite, Valerie, et al. (2007) “Taxation Threat, Motivational Postures, and Responsive Regulation,” 29 Law & Policy 137–58.Google Scholar
Callahan, Patricia (2010) “FDA Won't Disqualify HIV Doctor Dr. Daniel Berger from Drug Studies,” Chicago Tribune, 9 Sept.Google Scholar
DiMaggio, Paul J., & Powell, Walter W. (1991) “Introduction,” in Powell, W., & DiMaggio, P., eds., The New Institutionalism in Organizational Analysis. Chicago: Univ. of Chicago Press.Google Scholar
Dobbin, Frank, & Kelly, Erin L. (2007) “How to Stop Harassment: Professional Construction of Legal Compliance in Organizations,” 112 American J. of Sociology 1203–43.CrossRefGoogle Scholar
Douglas, Mary (1986) How Institutions Think. Syracuse, NY: Syracuse Univ. Press.Google Scholar
Duckett, S. J. (1983) “Changing Hospitals: The Role of Hospital Accreditation,” 17 Social Science & Medicine 1573–79.CrossRefGoogle ScholarPubMed
Edelman, Lauren B., et al. (1999) “The Endogeneity of Legal Regulation: Grievance Procedures as Rational Myth,” 105 American J. of Sociology 406–54.CrossRefGoogle Scholar
Edelman, Lauren B., et al. (2011) “Judicial Deference to Institutionalized Employment Structures,” 117 American J. of Sociology 888–954.CrossRefGoogle Scholar
Flood, Ann Barry, & Fennell, Mary L. (1995) “Through the Lenses of Organizational Sociology: The Role of Organizational Theory and Research in Conceptualizing and Examining Our Health Care System,” 35 J. of Health & Social Behavior 154–69.CrossRefGoogle Scholar
Gilboy, Janet A. (1997) “Implications of ‘Third-Party’ Involvement in Enforcement: The INS, Illegal Travelers, and International Airlines,” 31 Law & Society Rev. 505–30.CrossRefGoogle Scholar
Goffman, Erving (1959) The Presentation of Self in Everyday Life. Garden City, NY: Doubleday.Google Scholar
Grabosky, Peter, & Braithwaite, John (1986) Of Manners Gentle: Enforcement Strategies of Australian Business Regulatory Agencies. Melbourne & New York: Oxford Univ. Press.Google Scholar
Hawkins, Keith (1984a) “Creating Cases in a Regulatory Agency,” 12 J. of Contemporary Ethnography 371–96.Google Scholar
Hawkins, Keith (1984b) Environment and Enforcement: Regulation and the Social Definition of Pollution. Oxford, UK: Clarendon Press.CrossRefGoogle Scholar
Heimer, Carol A. (1999) “Competing Institutions: Law, Medicine, and Family in Neonatal Intensive Care,” 33 Law & Society Rev. 17–66.CrossRefGoogle Scholar
Heimer, Carol A. (2008) “Thinking About How to Avoid Thought: Deep Norms, Shallow Rules, and the Structure of Attention,” 2 Regulation and Governance 30–47.CrossRefGoogle Scholar
Heimer, Carol A., et al. (2005) “Risk and Rules: The ‘Legalization’ of Medicine,” in Hutter, B., & Power, M., eds., Organizational Encounters with Risk. Cambridge, UK: Cambridge Univ. Press.Google Scholar
Hutter, Bridget M. (2006) “The Role of Non State Actors in Regulation,” in Schuppert, F., ed., Contributions to Governance. Berlin: Nomos.Google Scholar
Kolko, Gabriel (1965) Railroads and Regulation, 1877–1916. Princeton, NJ: Princeton Univ. Press.CrossRefGoogle Scholar
Larson, Erik W. (2004) “Institutionalizing Legal Consciousness: Regulation and the Embedding of Market Participants in the Securities Industry in Ghana and Fiji,” 38 Law & Society Rev. 737–68.CrossRefGoogle Scholar
Levi-Faur, David, & Jordana, Jacint (2005) “The Making of a New Regulatory Order: Preface,” 598 Annals of the American Academy of Political & Social Sciences 6–9.CrossRefGoogle Scholar
Lipsky, Michael (1980) Street-Level Bureaucracy: Dilemmas of the Individual in Public Services. New York: Russell Sage.Google Scholar
MacCannell, Dean (1973) “Staged Authenticity: Arrangements of Social Space in Tourist Settings,” 79 American J. of Sociology 589–603.CrossRefGoogle Scholar
May, Peter J. (2004) “Compliance Motivations: Affirmative and Negative Bases,” 38 Law & Society Rev. 41–68.CrossRefGoogle Scholar
McBarnet, Doreen, & Whelan, Christopher (1991) “The Elusive Spirit of the Law: Formalism and the Struggle for Legal Control,” 54 The Modern Law Rev. 848–73.CrossRefGoogle Scholar
Meyer, John W., & Rowan, Brian (1977) “Institutionalized Organizations: Formal Structure as Myth and Ceremony,” 83 American J. of Sociology 340–63.CrossRefGoogle Scholar
O'Brien, Judith A., et al. (2000) “Clinical Practice Guidelines and the Cost of Care: A Growing Alliance,” 16 International J. of Technology Assessment in Health Care 1077–91.CrossRefGoogle Scholar
Parker, Christine (2006) “The ‘Compliance’ Trap: The Moral Message in Responsive Regulatory Enforcement,” 40 Law & Society Rev. 591–622.CrossRefGoogle Scholar
Power, Michael (1997) The Audit Society: Rituals of Verification. Oxford, UK: Oxford Univ. Press.Google Scholar
Rees, Joseph V. (1988) Reforming the Workplace: A Study of Self-Regulation in Occupational Safety. Philadelphia: Univ. of Pennsylvania Press.CrossRefGoogle Scholar
Schneiberg, Marc, & Bartley, Tim (2008) “Organizations, Regulation, and Economic Behavior: Regulatory Dynamics and Forms from the Nineteenth to Twenty-First Century,” 4 Annual Rev. of Law and Social Science 31–61.CrossRefGoogle Scholar
Selznick, Philip (1992) The Moral Commonwealth. Berkeley, CA: Univ. of California Press.Google Scholar
Vaughan, Diane (1999) “The Dark Side of Organizations: Mistake, Misconduct, and Disaster,” 25 Annual Rev. of Sociology 271–305.CrossRefGoogle Scholar
Vogel, Steven K. (1996) Freer Markets, More Rules: Regulatory Reform in Advanced Industrial Countries. Ithaca, NY: Cornell Univ. Press.Google Scholar
Waller, Vivienne (2007) “The Challenge of Institutional Integrity in Responsive Regulation: Field Inspections by the Australian Tax Office,” 29 Law & Policy 67–83.CrossRefGoogle Scholar